WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study

WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study

WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study

NURS 6501 Week 2 Discussion

There are two files attached: one is the case study that will be utilized to develop the care plan and concept map, and the other is the concept map. For comprehensive implementation, the case study should be well grasped. The diagnosis should be worded appropriately (Problem __ relates to __ as evidenced by ). A time frame should be included in the planning. The intervention should be carefully worded, with acceptable rationales and references. Evaluations should be reasonable, with explanations if they are fulfilled, partially met, or unmet (f goals are unmet or are only partially met, you should continue the intervention).

I need a tutor with deep nursing background and understanding to pick this up. Please do not bid if you have a peripheral understanding of writing a careplan. This is 50% of my grade and need to be done well. WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study

CHAPTER 1  CARDIOVASCULAR DISORDERS  CASE STUDY 3

INSTRUCTIONS All questions apply to this case study. Your responses should be brief snd to the point. When asked to provide several answers, list them in order of priority or significance. Do not assuma information that is not provided. Please print or write clearly. If your response is not laglble, it witl be marked as ? and you will need to rewrite It.

You are a nurse at a freestanding cardiac prevention and rehabilitation center. Your new patient in risk-factor modification is B.T., a 41-year-old traveling salesman, who is married and has three children. He tells you that his work does not let him slow down. During a recent evaluation for chest pain, he underwent a cardiac catheterization procedure that showed moderate single-vessel disease with a 50% stenosis in the mid right coronary artery (RCA).

He was given a prescription for sublingual (SL) nitroglycerin (NTG), told how to use it, and referred to your cardiac rehabilitation program for sessions of 3 days a week. B.T.’s wife comes along to help him with healthy lifestyle changes. You take a nursing history, as indicated in the following. WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study

Family History

Father died suddenly at age 42 of a myocardial infarction (MI)

mother (still living) had a quadruple coronary artery bypass graft (CABG x 4) at age 52

Past History and Current Meilications

Metoprolol (Lopressor) 2S mg PO every 12 hours Aspirin (ASA) 325 mg per day PO

Simvastatin (2iocor) 20 mg PO every evening

WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study Lifestyle Habits

Smokes an average of IN packs of cigarettes per day (PPD) for the past 20 years Drinlis an ”occasional“ beer, and ‘a 6-pack every weekend when watching football” Dietary history: High in fried and fast foods because of his traveling

Exercise: ‘I don’t have time to take walks.” General Assessment

White Male

Weight                                                                235 lb

Height                                                                 5 ft, 8 in.

Waist circumference                                       48 in.

Blood pressure                                                 148/88 mm Hg

Pulse                                                                   82 beats/min

Respiratory rate                                              18 breaths/min

Temperature                                                     98.4° F (36.9° C)

  1. Calculate T.’s smoking history in terms of pack-years.
  2. There are several risk factors for coronary artery disease (CAD). For each risk factor listed, mark whether it is nonmodifiable or modifiable. WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study
    1. Age
    2. Smoking
    3. Family history of CAD
    4. Obesity
    5. Physical inactivity
    6. Gender
    7. Hypertension
    8. Diabetes mellitus
    9. Hyperlipidemia
    10. Ethnic background
    11. Stress
    12. Excessive alcohol use
  3. Circle the nonmodifiable and modifiable risk factors that apply to T.
    • You review B.T.’s most recent lab results.
      • +J Chart View
      • Laboratory Testing (Fasting)
      • Total cholesterol                 240 mg/dL
      • HDL                                        35 mg/dL
      • LDL                                         112 mg/dL
      • Triglycerides       178 mg/dL
  1. Which lab values are of concern at this time? Explain your answers.
  2. T. asks you, “So, how is my ’good cholesterol’ doing today?” Which is considered the “good cholesterol and why? What do his HDL and LDL levels indicate to you?
  3. B.T. laughingly tells you he believes in the five all-American food groups: salt, sugar, fat, chocolate, and caffeine.
  4. Identify health-related problems in this case description; the problem that is potentially life threatening should be listed
  5. Of all of his behaviors, which one is the most significant in promoting cardiac disease?
  6. What is the highest priority problem that you need to address with T.? How will you determine this? Identify the teaching strategy you would use with him. WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study
  7. What is the second problem yéiu would work with T. to change? Identify an appropriate strategy to resolve the problem.
  8. B.T.’s wife takes you aside and tells you, “I’m so worried for B. I grew up in a really dysfunctional family where there was a lot of violence. B. has been so good to the kids and me. I’m so worried I’ll l‹›.se him that I have nightmares about his heart stopping. I find myself suddenly awaken ing at night just to see if he’s breathing” How are you going to respond? WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study
  9. Six weeks after you start working with B.T., he admits that he has been under a lot of stress. He is walking on the treadmill and rubs his chest and says,“lt feels really heavy on my chest right nowt You feel his pulse and note that his skin is slightly diaphoretic and that he is agitated and appears to be anxious. WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study
  10. What is the first action you are going to do? What other information will you obtain?
  11. T. is still uncomfortable, and he has an unopened bottle of sublingual nitroglycerin (SL NTG) tablets. You decide to give him one tablet. After 5 minutes, which is the appropriate action to take? WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study
    1. If the chest discomfort is relieved, call
    2. If the chest discomfort is not relieved, give another SL NTG tablet, and wait 5 minutes
    3. If the chest discomfort is not relieved, have someone else call 911, while you give T. another SL NTG tablet.
  12. If the chest discomfort is not relieved, do a 12-lead electrocardiogram (ECG) to look for ischemic changes, and call 911What other actions will you take at this time?
  13. Five minutes after the first NTG tablet, T. states that the discomfort is still there and only slightly relieved. Explain what you can expect to be doing while waiting for emergency medical system (EMS) to arrive.

B.T. is transported to the ED of a local hospital and undergoes another cardiac catheterization with coronary stent placement. WU NURS 6501 Week 2 Advanced Pathophysiology Adenocarcinoma of The Colon Case Study